E-ISSN:2456-3110

Case Report

Type 2 Diabetes Mellitus

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 11 December
Publisherwww.maharshicharaka.in

Effect of Bhunimbadi Churna in management of Uncontrolled Type 2 Diabetes Mellitus - A Case Study

Kumar A.1*, Wasnik K.2, Ram Mahto R.3
DOI:

1* Akshay Kumar, Post Graduate Scholar, Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi, India.

2 Kundan Wasnik, Post Graduate Scholar, Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi, India.

3 Raja Ram Mahto, Assistant Professor, Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi, India.

Background: A global epidemic with serious public health repercussions is diabetes mellitus (DM). A well-known, multifactorial metabolic disorder known as hyperglycemia is characterized by exceptionally high blood glucose levels brought on by an absolute or relative insulin deficiency. Ninety percent of all diabetics have type-2 diabetes, which is the most prevalent kind of the disease. The disease DM is mentioned in classical Ayurvedic texts as Madhumeha. The Prabhoota Mutrata (Polyuria) is a cardinal symptom of disease. Presentation of the case: A 58-year-old Indian man with burning sensation in both eyes along with increased frequency of micturation was presented to O.P.D. of Kayachikitsa, based on a high HbA1c and fasting blood sugar, as well as polyuria, the Patient was diagnosed with uncontrolled diabetes mellitus. The patient was advised an Ayurvedic oral medication, dietary modification, and Yoga. After a month of Ayurvedic treatment, the Patient was able to get rid of his symptoms along with reduced HbA1C and Blood glucose levels. Conclusion: Diseases that pose a threat to one's life can be treated holistically, safely, and effectively with ayurveda. Diet and yoga advice acts as part of the diabetes therapy strategy.

Keywords: Case report, Type 2 Diabetes Mellitus, Polyuria, Ayurveda, Uncontrolled Diabetes

Corresponding Author How to Cite this Article To Browse
Akshay Kumar, Post Graduate Scholar, Department of Kayachikitsa, All India Institute of Ayurveda, , New Delhi, India.
Email: 		Akshay Kumar, Kundan Wasnik, Raja Ram Mahto, Effect of Bhunimbadi Churna in management of Uncontrolled Type 2 Diabetes Mellitus - A Case Study. J Ayu Int Med Sci. 2022;7(11):232-237.
Available From
https://jaims.in/jaims/article/view/1978

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-11-01 2022-11-03 2022-11-10 2022-11-17 2022-11-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2022by Akshay Kumar, Kundan Wasnik, Raja Ram Mahtoand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Kumar A et al: Bhunimbadi Churna in Uncontrolled Type 2 Diabetes Mellitus

Introduction

Diabetes, along with respiratory illness, cancer, and cardiovascular disease (CVD), is one of the biggest worldwide health concerns of the twenty-first century.[1] Nearly 592 million people are expected to die from diabetes by the year 2035.[2] Previously thought to be a disease of the wealthy "Western" nations, type 2 diabetes, which accounts for 90% of all cases of diabetes, has expanded internationally and is now a leading cause of disability and mortality for increasingly younger age groups. Diabetes has become a pandemic in several emerging nations, including China and India.[3]

Diabetes is a chronic metabolic disease characterized by hyperglycemia (or blood sugar) levels that harm the heart, blood vessels, eyes, kidneys, and nerves.[4] Diabetes has been considerably more prevalent in recent years due to sedentary lifestyles and poor dietary habits, both of which are key etiological factors for the condition.[5]

Excess body weight, bad eating habits, and a sedentary lifestyle are all factors in this kind of diabetes.[6] The most common signs of this condition are polyuria (frequent urination), polydipsia (increased thirst), and polyphagia (increased appetite).[7] As a result, the illness may go untreated for years and only manifest clinically after problems have arisen.

Ayurvedic classical texts indicated 20 categories of Prameha depending on urine properties, volume, and dhatu discharged by urine.[8] Only Madumeha[8]/Ojameha[9]/Kshaudrameha[10] bear a close similarity to Diabetes mellitus, a Vataja sub-type of the disease. Because of Virudhopkramatvat (distinct/opposite management), this form of Prameha is termed Asadhya (incurable).[11] Madhumeha is caused by Dhatvagnimandya (weak digestive fire), and diabetes mellitus is also a metabolic condition, hence the two are related. Dhatvagnimandya (weak digestive fire) is a vital aspect of the Samprapti (pathogenesis), and as Agni (digestive fire) is disrupted owing to different circumstances that disrupt the Tridosha (three regulatory functional factors of the body) equilibrium. As a result, ingested food is turned to Ama (bio-toxin), and the Dhatuposhana (nourishment of Dhatu) and Dhatu-Utpatti processes are impeded.

The importance of "Ayurveda" in preventing and managing this chronic life-threatening illness is now well acknowledged worldwide. Simple lifestyle modifications, along with Yoga and Ayurvedic therapies, can help prevent and manage type 2 diabetes. In the current case study, the patient was prescribed the Ayurvedic medications listed below.

Bhunimbadi Churna 6 gm BD, along with dietary modification and Yoga advice for diabetes management. The present study aims to explore our experience of diabetes management through Ayurveda.

Timeline
Timeline of the events.

2021-11-18

The patient came complaining of burning sensation in both eyes along with increased frequency of micturation with raised level of blood glucose level and HbA1C level. Urine examination also showed glucose. Liver function test showed elevated level of SGPT along with normal value of other parameters. The patient was advised to take Ayurveda medication, dietary and lifestyle modification, and yoga for diabetes management.

2021-12-07

The report showed high blood sugar levels but the value decreased in respect to previous report.

2022-01-24

The patient told Improvement in symptom of polyuria and burning sensation along with blood investigation showed marked improvement in Fasting blood glucose level.

2022-02-22

Fasting blood sugar was decreased and urine examination showed decreased secretion of urine glucose. Marked improvement in HbA1c and fasting blood sugar. The patient was advised to continue the medication along with dietary and lifestyle modification.

Narrative: A 58-year-old man came to O.P.D. with increased appetite, burning sensation in B/L eyes, weight loss and polyuria. According to the patient he was asymptomatic 2 months ago gradually he noticed there is blackishness over his face and he started losing weight. Along with that there is increased frequency of micturition.


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So, he consulted to the nearby physician and gets investigated. In the investigations his blood sugar level is raised. Now he came in O.P.D. for the further management. The patient's detailed medical history revealed that he was also suffering from nocturnal polyuria and the timeline of the events was described in detail in Table 1.

Past H/o: He had No history of diabetes/bronchial asthma/Tuberculosis and hypertension.

Family H/o: No family history of diabetes / hypertension / Bronchial asthma / Tuberculosis

Addiction H/o: He had no addiction history of smoking, tobacco and alcohol.

Diagnostic Criteria Diagnosis will be made based on symptoms and laboratory investigation along with clinical findings.

Madhumeha Lakshana

  • Prabhuta Mutrata (Polyuria)
  • Avila-Mutrata (unclear urine)
  • Kshudhaadhikya (polyphagia)
  • Pipasaadhikya - Gala Talushosha (polydipsia)
  • Daurbalya / Shrama (exhaustion/tiredness)
  • Suptaangta / Daaha (Polyneuritis- numbness, tingling, burning soles)
  • Pindikodveshtan (Cramps while walking/calf muscle pain)
  • Vibandha (Constipation)
  • Alasya (Lethargy)
  • Sheet Priyata (desire for cold food and environment)
  • Sweda (excessive perispiration)
  • Mutra Abhidhavanti Pippilikasha (Ants observed in urinated area)
  • Madhuramasyata (feeling sweetness in mouth)

Clinical Finding
General Examination and Personal history: General Condition of the patient was good. No deviation in vital signs. He is Hindu of Indian ethnicity. He had a moderate appetite, Normal bladder, constipated bowel habit and regular sleep pattern. He had a sedentary life style, well-built and well nourished. He had BMI 25.8 and weight 66kg. His Prakriti was Vata Pittaja Dominant. He had Madhyama Satva.

Diagnostics

Table 2: Laboratory investigations in different phases of treatment.

Date Type Value Unit
2021-11-17 Hb 17 g/dl
2021-11-17 Platelet Count 241000 /mm3
2021-11-17 Blood Glucose Fasting 190 mg/dl
2021-11-17 Blood Glucose Post Prandial 294 mg/dl
2021-11-17 S.G.O.T. 53 U/L
2021-11-17 S.G.P.T. 26 U/L
2021-11-17 Serum Creatinine 1.29 mg/dl
2021-11-17 Blood Urea 22.50 mg/dl
2021-11-17 Alkaline Phosphatase 84 U/L
2021-11-17 Total Protein 8.39 g/dl
2021-11-17 BMI (body mass index) 25.8 kg/square meter
2021-11-17 HbA1C 12.2  %
2021-12-05 Blood Glucose fasting 158 mg/dL
2021-12-05 Blood Glucose post prandial 220 mg/dL
2022-01-24 Blood Glucose fasting 202 mg/dL
2022-01-24 Blood Glucose post prandial 372 mg/dL
2022-02-21 Blood Glucose fasting 142 mg/dL
2022-02-21 Blood Glucose post prandial 301 mg/dL
2022-02-21 BMI (body mass index) 24.5 kg/square meter
2022-02-21 HbA1C 7.7 %

Therapeutic Intervention: The patient was given for Bhunimbadi Churna 6gm BD (Table 02). The above said treatment was given for three month. The patient obtained great alleviation from the aforesaid treatment at follow-up.

Table 3: Ingredients of the formulation.

SN Formulation Ingredients
1. Bhunimbadi Churna Bhunimba (Andrographis paniculata )
Nimba (Azadirachta indica)
Triphala (Terminalia chebula,
Terminalia bellirica, Emblica officinalis)
Padmak (Prunus cerasoides)
Ativisha (Aconitum heterophyllum)
Pippali (Piper longum)
Murva (Marsdenia tenacissima)
Patola (Trichosanthes Dioica)
Nisha (Curcuma longa)
Patha (Cissampelos pareira)
Kutki (Picorrhiza kurroa)
Indravaruni (Citrullus colocynthis)
Kalinga (Holarrhena antidysenterica)
Vacha (Acorus calamus)
Dantimula (Baliospermum montanum)
Trivrita (Operculina turpethum) Brahmi (Bacopa monnieri)

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Dietary and lifestyle modification

According to Sushruta, avoiding the etiological factor (Nidana Parivarjana) is one of the preventative and therapy approaches for all diseases. The patient was advised a detailed diet plan for week which he was followed (Supplementary file 1). After a thorough consultation, Yoga and Pranayam were prescribed. Restricting one's diet and changing one's lifestyle are all suggested. At follow-up, the patient reported significant relief from the aforementioned symptoms.

Result

As indicated in table 03, the treatment was effective from the patient's sign and symptoms as well as in terms of biochemical indicators. Fasting blood glucose level and HbA1C both improved as a result of the treatment.

Table 4: Overall effect of treatment on blood glucose level.

Parameter Before treatment 30th day 60th day 90th day
FBS 190 mg/dl 153 mg/dl 202 mg/dl 142 mg/dl
PP-BS 294 mg/dl 283 mg/dl 372 mg/dl 301 mg/dl
HbA1C 12.2% - - 7.7%

Dietary and lifestyle modification

According to Sushruta, avoiding the etiological factor (Nidana Parivarjana) is one of the preventative and therapy approaches for all diseases. The patient was advised a detailed diet plan for week which he was followed (Supplementary file 1). After a thorough consultation, Yoga and Pranayam were prescribed. Restricting one's diet and changing one's lifestyle are all suggested. At follow-up, the patient reported significant relief from the aforementioned symptoms.

Discussion

The type of Madhumeha Samprapti mentioned in the old Ayurvedic texts include Vishishta Anilatmaka, Dhatukshayajanya, Kala Prabhavaja, and Avarana Janya Madhumeha.[12] Because of its distinctive / opposite administration, or Virudhopkramatvat, this kind of Prameha is regarded as Asadhya. Since Agni (digestive power) is disturbed by a variety of things that throw off the equilibrium of the Tridosha, Dhatvagnimandya

is a fundamental part of the Samprapti. As a result, eating causes the production of Ama (bio-toxin), which interferes with Dhatuposhana and Dhatu-Utpatti. In Prameha, Medodhatvagni-mandya is especially observed. Similar to Dhatu Kshaya in Ayurveda, diabetes mellitus (Madhumeha) also results in degenerative changes in the body, particularly in the pancreatic islets.

Further, it is important to mention the similarities between Diabetes mellitus and Madhumeha. Nidana of Madhumeha like Madhura, Guru, Snigdha, Amla, Lavana Bhojana, Nidra- Aasyasukha, Avyayam[13] etc., can be correlated with sedentary life style, the main cause of Diabetes mellitus. Also, genetic factors mentioned as the cause of Diabetes mellitus can be correlated with the Bijadosha and Kulaja Dosha mentioned in Ayurveda. Prabhoota-Avila Mutra, the Pratytma Linga of Prameha can be correlated with polyuria and turbidity of urine found in Diabetes mellitus.

As a result, the goal of the therapy should be to get Agni back. Drugs should have Kaphamedohara and Vata Hara characteristics as well as Rasayana and Balya effects because all Dhatus are involved in Ojakshaya. One of Chikitsa's quadrupeds, a medication, is essential for the treatment of the illness. Ayurvedic practises suggest that Prameha can be safely treated with herbal medicines. The medications Bhunimbadi Churna from Astang Hridya Kushta Chikitsa Sthana were taken from the traditional book.

The Indian plant Andrographis paniculata has been used for a variety of things, but is most famous for avoiding diabetes mellitus (DM).[14] Diabetes and other conditions like inflammatory, cognitive, and mental diseases are frequently treated with A. paniculata extracts.[15] Animal study on the herb revealed that in type 1 Diabetes mellitus rats, ethanol extracts of this plant can lower blood glucose levels.[16] Azadirachta indica, a component of Nimbadi Kashyam, may aid in the management of type 2 Diabetes mellitus by increasing the production of GLUT4 protein and insulin signaling molecules, which enhances skeletal muscle oxidation.[17] It has been shown that the active compounds nimbinin and nimbandiol have a potent blood sugar-regulating action.[18]

The trial drugs have Katu, Tikta and Kashaya Rasa which pacify the Kapha Dosha and Kleda in the


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body, thus help in alleviating this symptom. Katu Rasa is Shoshaka, Sneha-Sweda-Kledahara, & Kapha Shamaka, Tikta Rasa is Kleda-Meda-Vasa-Majja-Puya-Mutra-Purish–Pitta-Shlasamashoshak and Kashaya Rasa is Sangrahi, Stambhana, Sleshama-Rakta-Pitta Prasaman and Sharer Kleda Shoshaka.[19] Thus, all these properties act on Dosha Vishesha i.e., Bahu Drava Sleshama and Dushya Vishesha i.e., Kleda. Further, drugs with their Laghu, Ruksha, and Tikshnaguna cause depletion of Kapha and Meda, leading to Samprapti Vighatana. Katu Vipaka of Dravya also works on Mutravaha Srotsa and reduces Kleda, Meda and hence, decreases the frequency of urine.

Danti (Baliospermum montanum), Triphala (Terminalia chebula Retz., Terminalia bellerica, Emblica officinalis), are considered to act on abnormally stored Kapha Dosha and Medas due to their Rookshana property. It also contains Tikshna and Ushna medications such as Pippali, Danti, and others that have a favorable effect on Srotovishodhana.

To break the Samprapti, Tikta, Katu, Kashaya Rasa; Laghu, Ruksha Guna; Ushna Virya, and Katu Vipaka correct Kapha Dushti and Medo Dhatu Dushti and cleanse Dhatvagnimandya, the bulk of the drugs in this formulation include Deepana, Pachana, and Lekhana properties. Additionally, Tridosha Shamaka (mostly Kaphavatahara) is a medicinal combination that helps treat Vata Dushti. Effects of the Laghu and Rooksha Guna include Kledashoshak and Mootrasangrahaniya. In the end, these characteristics help to relieve Kshudha-Adhikya and Prabhoota-Avila Mutrata (increased turbid urination) (Polyphagia). Additionally, the combination provides the body with nourishment through the qualities of its constituents' Balya, Jeevaniya, and Rasayana, which stop Dhatu depletion and restore the patients' Bala (strength). The components of the Combination had a significant hypoglycemic impact, leading to progression towards health.

Conclusion

Ayurvedic therapy considerably reduced polyuria and polydipsia, two symptoms of diabetes. In conjunction with dietary and lifestyle adjustments, Ayurveda resulted in substantial improvements in HbA1c and fasting blood sugar levels.


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